Of sex and science. Elizabeth Pisani's blog about HIV and other sundry things.

28/02/08

After huddling late into the night, US politicians have come up with a compromise. They’ll spend more money on innnocent victims of AIDS, but none to protect those wicked people who sell sex for a living.

The US congress house of representatives House Committee on Foreign Affairs agreed to spend an astonishing US$ 50 billion of US taxpayers’ money on overseas HIV/AIDS treatment over the next five years. (US President George Bush had only asked for US$ 30 billion.) Here’s what acting chairman Howard Berman had to say:

Twenty million innocent men, women and children, we must remember, have perished from HIV/AIDS – 20 million. Forty million around the globe are HIV-positive. Each and every day, another 6000 people become infected with HIV. We have a moral imperative to act, and act decisively…In response to the desperate need for lifesaving medicine and new health care workers in nations hit hard by HIV/AIDS, the bill before us authorizes $50 billion over five years.

(my emphasis)

Care providers are whingeing that the bill will undermine treatment because a 55% minimum for spending on treatment has been dropped, but that doesn’t seem likely. Spending money on medicine is easy and popular both at home and abroad. So I’ll bet most of the money will still be spent on (US-made medicines) and their delivery. Happily, the rule that has so far shovelled over a billion dollars into the black hole of abstinence-only programmes has been dropped. But since our concern is for the innocent, the anti-prostitution loyalty oath stays, despite the best efforts of Bound, Not Gagged and others. This compels organisations who accept any one of the 50 billion dollars on offer to refuse to recognise sex work, thus making it extremely difficult to work effectively with those (wicked, naturally) people who sell and buy sex, even with money from other sources. Some commentators suggest that the Democrats didn’t even bother to fight this one in the compromise bill. If that’s true, shame on them.

Another anomaly: no PEPFAR money can be used to provide contraceptives. US taxpayers are committed under this bill to help infected women avoid passing HIV on to their infants. They’re committed to pay for expensive antiretroviral treatment for the kids if the prevention programmes fail. They’re committed to supporting orphans left behind once those infected women die of AIDS. But they can’t help HIV positive women avoid getting pregnant in the first place. Go figure.

Needle exchange update:The use of PEPFAR money to support sterile needle programmes for drug injectors was not mentioned in any of the official reporting on the compromise bill. The earlier Democrat version of the bill (pdf full text here) appeared to leave the door open for funding needle exchange, which is vital to countries such as Vietnam, by talking vaguely about “evidence-based prevention”. I haven’t been able to get hold of the full text of the compromise bill, so don’t know whether this door to common sense and fewer infections has also been closed.